TY - JOUR
T1 - Characteristics of Ventricular Tachycardia Ablation in Patients with Continuous Flow Left Ventricular Assist Devices
AU - Sacher, Frederic
AU - Reichlin, Tobias
AU - Zado, Erica S.
AU - Field, Michael E.
AU - Viles-Gonzalez, Juan F.
AU - Peichl, Petr
AU - Ellenbogen, Kenneth A.
AU - Maury, Philippe
AU - Dukkipati, Srinivas R.
AU - Picard, Francois
AU - Kautzner, Josef
AU - Barandon, Laurent
AU - Koneru, Jayanthi N.
AU - Ritter, Philippe
AU - Mahida, Saagar
AU - Calderon, Joachim
AU - Derval, Nicolas
AU - Denis, Arnaud
AU - Cochet, Hubert
AU - Shepard, Richard K.
AU - Corre, Jerome
AU - Coffey, James O.
AU - Garcia, Fermin
AU - Hocini, Meleze
AU - Tedrow, Usha
AU - Haissaguerre, Michel
AU - D'Avila, Andre
AU - Stevenson, William G.
AU - Marchlinski, Francis E.
AU - Jais, Pierre
N1 - Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2015/6/4
Y1 - 2015/6/4
N2 - Background - Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias. This study describes ventricular arrhythmia characteristics and ablation in patients implanted with a Heart Mate II device. Methods and Results - All patients with a Heart Mate II device who underwent ventricular arrhythmia catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58±10 years) underwent 39 ablation procedures. The underlying cardiomyopathy pathogenesis was ischemic in 21 and nonischemic in 13 patients with a mean left ventricular ejection fraction of 17%±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs; cycle lengths, 230-740 ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation because of intractable VT. Only 10/110 (9%) of the targeted VTs were related to the Heart Mate II cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25±15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT. Conclusions - Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, seems to be the dominant substrate.
AB - Background - Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias. This study describes ventricular arrhythmia characteristics and ablation in patients implanted with a Heart Mate II device. Methods and Results - All patients with a Heart Mate II device who underwent ventricular arrhythmia catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58±10 years) underwent 39 ablation procedures. The underlying cardiomyopathy pathogenesis was ischemic in 21 and nonischemic in 13 patients with a mean left ventricular ejection fraction of 17%±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs; cycle lengths, 230-740 ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation because of intractable VT. Only 10/110 (9%) of the targeted VTs were related to the Heart Mate II cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25±15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT. Conclusions - Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, seems to be the dominant substrate.
KW - ablation
KW - ventricular arrhythmia
KW - ventricular assist device
KW - ventricular tachycardia
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U2 - 10.1161/CIRCEP.114.002394
DO - 10.1161/CIRCEP.114.002394
M3 - Article
C2 - 25870335
AN - SCOPUS:84942856270
VL - 8
SP - 592
EP - 597
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
SN - 1941-3149
IS - 3
ER -